Homestead_Hurst (6)\
CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD/SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R73 / 12-09)
� I PresmLed by Iha DepartmaM o( Local Gwemment Firiance
INSTRUCTIONS: See ieverse slde (orlling insGuctions.
FORM
HC10
YEAR
. �
��yye� certiry that � ) . pa�
place of residence or am (are) buying the fdlowing described real property for which a Hanestead Property Tax Sfandard Deducfion is hereby daimed
�er mntract on �he date this application is filed, (date of filing). I(VJe): AP R 1 6 Z��Z
Own ❑!vn (are) buying under recorded conVacl C�
❑ Am (are) entitled to occupy as a tenant-stockholder of a cnoperative housing corporation
❑ Have a henefidal interest in Me Wst or the right to occupy ihe property under the tertns of a qualified personal residence Wst
❑ Am (are) the shareholder, partner or member of the entity that owns ihe property. GIBSON COUNTY AUDITOR
•• • •
Nama t(legalneme) � � � �p� �� .
/ Lp�,.�'�µi
ca��--�
Name ol deimanfs spouse (legal name)
Social Seqmry number of t�launanYs sp�wse (WSt (ire dg'#s) Drivefs 6certse / Itlentlfiption / Other number IssWng State
or aatrnanrs spouse (lasr rrve d'gitcJ
e •'� �
If buy'ug on convact Fee Sirt�pte rnmers fwne
Recwdels otfice where mntrect is fecorded Record'wmber Page
..�. . � . �
�� To.vnshiD Tawfg d' ' (dty, town. (awnshiP)
Patmi number L/�egal desaiption 7. O 80 .4 C ts the pmperty in Ouestion:
r I E/J E� � ' a— ❑ Real propeity ❑ Mnually assnssed mob�e home (IC b7.1-n
port;on of ine'esidenua� swaure a uie �arie not exceedina o�e (t � ave u�at immediateN s+,na,nas uiat swm,re is used ro croduce inmme, descibe me use arvf vw+bn
f Ue property utlized b pmCUCe Ncama.
� - �1-l(0-400-DOO.qy7-o �7
•.• . .: . .
Caunry TamshiP Counry Tamship
[�
I hereby certify Ne above statements are We, correG and complete. Signa' a' /
7
y-
nda�ess (�u�� ene sueec cA: sr�ra, am ziP
S S. 35c7 W r' Nc� o� �.✓. 7�o7v
�, � . . .. � . �
�� ..
tand not exceeding t (orre) acre immedlatery .'-�-= " � ?'`'� � �" � "�
surrountlin resldential Im rovement5. ��) � �' � �' ��`FN. ����t;�"'n¢�
�
z:s ` S-T`. -y��`�
Other land (2) � . _
rom� �a�,a p;no 1 plus q,re 2) (3)
Dwellin9 (<) �`�' `°•��`"Fa'.t'ae�� �m��
ResideMial Improvement5 or Annualty .
AssessedMObtle/Manu(actumdHome -i�`�"}'�5 �.� r.+s:"f:-�����
Gara9 5 �. � ,� `::
e � ) ..a,.� �..x._A�.. °�"`-X�..s_...e
� { . c�� ,,. _
Otherlmprovements (6) � �".-. �,-*?�:`-�
Totel improveme� (Ilne 1 Nrough fine 6) (7)
Total value (lirre ] plla Ilne 7) (8)
I hereby eertify the above is W e. correct, �9^a�re of Assessw Date si9ned (monN. daY. N�A
and complete.
Vailying allon - Sigreture Mlwditor �a� signed (rtwnN. day, yea�
� . - � � � • •
20 _ pay Z(1 _ Lesser of 60% of the essessed ralue of the homestead or $45,000
fJoMiM5lendirg any ofher provis»n, fhe wm o/ (he deduct'am provided in IC &/.7-12 to a moWle home Naf a $
not essessetl es real pioperty w to e menulactured haria Net is not assessed as reel property mey rat erceed
one-hel/ (12) olNe essessed velue W ttre mobile homa ormanulaUUred lartre.
S'rpia¢�2 o(lwditor Oate signed (mon(h, daY• Y��1
C .T.